Examining the Association Between Trauma Characteristics and Adult Depression and Anxiety: Analysis of Types,Variety,Repetition,and Timing of Past Trauma

Abstract

Past research has emphasized the impact of prior trauma on adult depression and anxiety rates. However, few studies have examined the simultaneous connection between various trauma characteristics (e.g., type, variety, repetition, timing) and symptoms of depression and anxiety in adults. Understanding how these different trauma characteristics relate to mental health issues can offer valuable insight into predicting the onset of such problems. We conducted a cross-sectional analysis with 356 adult participants to explore the associations between lifetime trauma history and depression/anxiety scores. Participants retrospectively reported on five different traumatic experiences from birth to the present, including childhood physical abuse, witnessing parental violence, lifetime experiences of rape, witnessing trauma to loved ones, and the unexpected death of loved ones. For each trauma type, participants indicated the timing of their first exposure and the frequency of subsequent occurrences. Depression and anxiety symptoms in the past 2 weeks were also self-reported. Multiple regression analyses with covariates were employed. On average, participants experienced two out of the five trauma types. Regardless of the type, having at least one traumatic experience was linked to higher depression and anxiety scores. Those who experienced all five trauma types reported the highest levels of depression and anxiety. Repeated instances of rape, witnessing trauma to loved ones, and the death of loved ones were significantly associated with elevated depression and anxiety scores. The timing of exposure to the unexpected death of loved ones predicted higher depression scores in childhood compared to adulthood, while no relationship between timing and anxiety scores was observed. Other trauma types did not show significant associations. Our study enhances knowledge of the link between trauma and depression/anxiety by elucidating how various trauma characteristics, such as type, variety, repetition, and timing of trauma, have differential influences on depression and anxiety scores.

Keywords

trauma child maltreatment intimate partner violence rape adult depression and anxiety

Introduction

Trauma can be particularly harmful as it increases the risk of mental health problems; depression and anxiety are among the most common mental health problems reported by individuals with trauma histories (Fernandes & Osorio, 2015; Heim et al., 2008; Mandelli et al., 2015). Therefore, to prevent the onset of adult depression and anxiety among trauma survivors, it is critical to understand how traumatic experiences increase the risk of depression and anxiety. Previous research has identified child maltreatment, witnessing parental intimate partner violence (IPV), bullying, and neighborhood violence as prevalent types of trauma in childhood (Croft et al., 2019; Kessler et al., 2010). Among adults, rape, IPV, unexpected death of loved ones, witnessing violence against others, and serious accidents are relatively common traumas (Hapke et al., 2006; Shakespeare-Finch & Armstrong, 2010).

Traumatic events in childhood and adulthood can have lasting effects on an individual’s mental health. A meta-analysis of 96 individual studies found that childhood trauma from physical abuse, sexual abuse, and exposure to IPV significantly increased the risk for depression and anxiety in adulthood (Gardner et al., 2019). Similarly, experiencing the unexpected death of loved ones, the most common form of traumatic experience among U.S. general population adults, was associated with a higher risk for adult depression and anxiety (Keyes et al., 2014). However, while these studies underscore the association between traumatic experiences and depression and anxiety in adulthood, there is less clarity about whether the characteristics of these trauma experiences have differential effects on mental health outcomes. This study seeks to address this gap in the literature by examining how the characteristics of lifetime trauma experiences (e.g., type, variety, repetition, timing) predict adult depression and anxiety symptoms.

Variety

Existing research indicates that experiencing a variety of traumas worsens mental health problems (Cloitre et al., 2009; Miller et al., 2011; Steine et al., 2017). This terminology captures the complexities of experiencing a variety of traumas, including the number of varied traumatic experiences (e.g., multiplicity) an individual undergoes in a lifetime. For example, experiencing more types of trauma (i.e., child maltreatment, being in foster care, having severe interpersonal conflicts, incarceration, homelessness, and death of a partner or a child) was related to higher depressive symptoms in adulthood (Cloitre et al., 2009; Shrira, 2012). Similarly, childhood sexual violence and IPV exposure were linked to a higher risk of anxiety than exposure to either child sexual maltreatment or IPV alone (Rapsey et al., 2019). Additionally, individuals who experienced child sexual, physical, and emotional abuse concurrently had an increased likelihood of adult depression compared to those experiencing one type of abuse (King, 2021).

Repetition

Repeatedly experiencing one form of trauma, which also captures the long duration of trauma exposures that are repeated during an individual’s lifetime (e.g., chronicity), can further intensify the severity of depression and anxiety symptoms. This pattern is particularly prevalent and studied widely among individuals with a history of repeated rape. For example, adult women with a history of repeated rape had higher depression scores than those without a history of repeated rape (Najdowski & Ullman, 2011). Similarly, women with multiple experiences of sexual abuse at any time in their lives had higher depressive and anxiety symptoms than women who experienced sexual abuse once (Messman-Moore et al., 2000). Repeated incidents of other forms of traumatic events, such as multiple experiences of losing loved ones, have also been shown to correlate with higher levels of depressive and anxiety symptoms (Shear, 2015).

Timing

Recent research has investigated whether the timing of exposure to traumatic events affects adult mental health, and several studies suggest that the relationship between timing and mental health issues may depend on the type of trauma experienced (Adams et al., 2018; Dunn et al., 2017). For instance, one study found that experiencing physical and sexual maltreatment during early childhood (birth to age five) was associated with greater levels of depression in adulthood than experiencing such trauma during adolescence or adulthood (Dunn et al., 2017). Another study suggested that experiencing rape or sexual abuse during childhood (ages 6–12 years) or adolescence (age 13 years and above), but not during early childhood (birth to age six), was linked to higher rates of depression and anxiety in early adulthood (Adams et al., 2018). The same study found that physical abuse during middle childhood, but not early childhood or adolescence, was significantly associated with depression and anxiety in early adulthood (Adams et al., 2018). However, for other trauma types, such as witnessing trauma to loved ones or losing loved ones, no differences in adult depression and anxiety were observed based on the timing of the event (Dunn et al., 2017).

Aims of the Current Research Study

While existing research consistently finds an association between childhood and adulthood trauma exposures and adult depression and anxiety, further work is needed to understand the impacts of varied trauma characteristics (types, variety, repetition, and timing) on adult depression and anxiety (Jackson et al., 2005). Our study analyzes cross-sectional data from a larger study on the correlates and consequences of child abuse and neglect to investigate the association between trauma exposure characteristics and adult depression and anxiety. We examine four different trauma characteristics: trauma types, variety of trauma exposures, repeated experiences with one type of trauma, and timing of past trauma. Four research questions are addressed: (a) Do different types of trauma experienced over a lifetime predict adult depression and anxiety scores?; (b) Does exposure to various trauma types in childhood or adulthood predict increased adult depression and anxiety scores?; (c) Does repeated exposure to a single type of trauma predict increased adult depression and anxiety scores?; and (d) Does the timing of first exposure to a specific form of trauma predict higher depression and anxiety scores in adulthood? Each question adds to a growing body of literature studying the association between different trauma characteristics and depression and anxiety in adulthood. We hypothesized that increased exposure to various types of trauma and repeated exposure to a single type would be linked to higher depression and anxiety symptoms. Lastly, we hypothesized that the timing of trauma would significantly predict depression and anxiety scores. Specifically, we predicted that exposure to trauma earlier would have a more negative impact than exposure later in life.

Method

Sample

Data are from the Lehigh Longitudinal Study (N = 457), which began in the 1970s with a sample of children and parents recruited from two counties’ child welfare agencies, daycare centers, and nursery programs in eastern Pennsylvania ( R. C.Herrenkohl et al., 1991; T. I.Herrenkohl et al., 2013). The current study used data from a subsample (n = 356) reassessed as adults in 2008 to 2010 at an average age of 36 years (age range between 31 and 41). All items used in this current study were measured when individuals were adults, except for one of the covariates (i.e., adolescent internalizing symptoms). The majority of study participants were White (78.7%, n = 280), 52.2% (n = 186) were male, and 47.8% (n = 170) were female. Among those who reported annual household income, the mean income ranged between $40,000 and $50,000. Please see Table 1 for the detailed demographic information. Institutional Review Boards at University of Michigan approved the study’s data collection and analysis procedures.

Table 1.

Sample Demographics Table.

Demographics	% (n)	Min.	Max.	Mean	SD
Sex (female)	47.80 (170)
Race (White)	78.70 (280)
Age		31	41	36.32	2.10
Household income		1 (<$10,000)	19 (>$200,000)	11.79 ($40,000–50,000)	5.37
Adolescent depression		0	46	11.70	9.06
Adult depression		0	52	9.34	8.95
Adult anxiety		0	21	4.95	5.18

Variables

Trauma history was measured with a self-report questionnaire adapted from the National Comorbidity Survey-Replication (NCS-R Section 18: Posttraumatic Stress Disorder), which included questions on exposure to 26 different adverse and traumatic events (Kessler & Merikangas, 2004; McCall-Hosenfeld et al., 2014; Nickerson et al., 2012). Seminal work by Kessler et al. has differentiated trauma into three types: interpersonal loss events, interpersonal trauma, and miscellaneous other adversities (Kessler et al., 1997). Per their guidelines, we chose five items across the three categories most frequently reported by our participants and identified as common traumatic events in the existing literature. The five traumatic events included in our analyses were as follows: one interpersonal loss event (lifetime unexpected death of loved ones), three interpersonal traumas (parental physical abuse in childhood, witnessing parental violence in childhood, lifetime rape), and one other trauma (witnessing trauma to loved ones in a lifetime). The NCS-R does not distinguish between childhood and adulthood trauma.

These are the four trauma characteristics studied in this article:

Type. We coded “no” (0) and “yes” (1), the five separate questions on the type of trauma individuals experienced: (1) “As a child, were you ever badly beaten up by your parents or the people who raised you?”; (2) “When you were a child, was there any physical violence between your father and mother (or between other caregivers)?”; (3) “Have you ever experienced rape?”; (4) “Did anyone very close to you ever have an extremely traumatic experience, like being beaten or raped?”; and (5) “Did someone very close to you ever die unexpectedly; for example, they were killed in an accident, murdered, committed suicide, or had a fatal heart attack at a young age?” Individuals in the group without exposure to one of the five specified traumas may have had exposure to another type of trauma.

Variety. We summed the total number of trauma types endorsed by each participant; the maximum number of trauma types experienced by individual participants was five.

Repetition. For each adverse and traumatic event that participants endorsed, participants were asked follow-up questions. We measured the repetition of a specific trauma through the follow-up question, “How many times did that [a specific trauma] happen in your life?” A wide distribution was observed: (a) 1 to 100,000 times for frequency of physical violence from parents; (b) 1 to 4,757 times for exposure to parental IPV; (c) 1 to 7,000 times for rape; (d) 1 to 3,000 times for witnessing the trauma of loved ones; and (e) 1 to 30 times for the unexpected death of loved ones. Therefore, scores above 100 for the first four types and above 10 for the last type were recoded to the next highest point on the scale to reduce the potential influence of outliers. For example, if individuals reported 5,000 occurrences of rape or 28 instances of the unexpected death of loved ones, these numbers would be recoded to 100 and 10, respectively.

Timing. We measured the timing of a specific trauma through another follow-up question, “How old were you the first time [this trauma occurred]?” Participants wrote down numerical values of the age when the trauma first occurred.

Depression in adulthood was measured using the Beck Depression Inventory (BDI), a self-report measure of depression severity (Beck et al., 1996). Participants were asked to report their depressive symptoms experienced in the prior 2 weeks, such as sadness, feeling discouraged, and frequency of crying. Each item was assessed using a three-point scale (0 indicating no symptoms and 3 indicating severe symptoms). Summed scores on the BDI ranged from 0 to 52; scores of 10 and above indicated the presence of clinical depressive symptoms (Beck et al., 1996). A higher score was associated with greater depressive symptoms. The scale has a good internal consistency (α = .91) with our data. Participants’ mean score for depression was 9.34 (equivalent to minimal depressive symptoms).

Anxiety in adulthood was measured using the General Anxiety Disorder-7 Scale, a self-report measure of anxiety severity (Spitzer et al., 2006). Participants reported anxiety symptoms experienced in the prior 2 weeks, such as nervousness, worry, and irritability. Each item was assessed using a three-point scale (0 indicating no symptoms and 3 indicating severe symptoms). Summed scores ranged from 0 to 21, and scores of 5 and above indicated the presence of clinical anxiety symptoms (Spitzer et al., 2006). A higher score was associated with greater anxiety symptoms. The scale has a good internal consistency (α = .89) with our data. Our participants’ mean score for anxiety was 4.95 (equivalent to minimal anxiety symptoms).

Covariates included adolescent internalizing symptoms and participant demographics (i.e., current age and sex). We used the age reported by the participants during adult wave 1 of the study. Sex was coded as “female” (0) and “male” (1). Adolescent internalizing symptoms were assessed with the Youth Self-Report Anxiety and Depression Scale (YSR) (Achenbach, 1991). We controlled for adolescent internalizing symptoms, as some studies suggest that a history of internalizing symptoms is a risk factor for adult depression and anxiety (Burcusa & Iacono, 2007). Sixteen items were measured on a scale from 0 “not true” to 2 “very true.” Scores were summed to create composite scores ranging from 0 to 29. Higher scores on the YSR were associated with greater levels of adolescent internalizing symptoms (i.e., anxiety and depressive symptoms).

Statistical Analysis

For descriptive analyses, we used SPSS (IBM, 2009). For statistical analyses, we utilized R (R Core Team, 2021). We performed Multivariate Imputation by Chained Equations, a type of multiple imputation, to address missingness across dependent variables and covariates (Buuren & Groothuis-Oudshoorn, 2010). We conducted a t-test (only for descriptive statistics) and multiple regression analyses (trauma characteristics: type, variety, repetition, and timing) to examine the association between trauma characteristics and adult depression and anxiety scores. Each of the trauma characteristics was a separate analysis. Therefore, we first ran the analyses for each trauma characteristic with depression as the outcome variable, followed by rerunning analyses with covariates. Then, we ran analyses with anxiety as the outcome variable, followed by rerunning analyses with covariates. Analyses with covariates served as sensitivity analyses to ensure the significance of our effects persisted even after accounting for the potential influence of demographic characteristics. All of our findings remained significant even after the addition of covariates.

Results

Trauma History

Just over a quarter (n = 97; 27%) of adult participants experienced one type of trauma; 24% (n = 87) experienced two types; 15% (n = 53) experienced three types; 10% experienced four types (n = 37); and 3% experienced five types (n = 11). A total of 20% (n = 71) of adults did not experience any of the five types of trauma, whereas 80% of participants experienced at least one type of trauma. The average number of traumatic experiences was two. The most common exposure type was the unexpected death of loved ones (n = 210; 59%), followed by exposure to IPV in childhood (n = 147; 41%), witnessed trauma to loved ones (n = 117; 33%), physical violence from parents in childhood (n = 81; 23%), and lifetime rape (n = 78; 22%). T-test results indicated that the average age of first exposure to trauma was 6.07 years for physical violence from parents (sd = 3.77, range = 0–16), 6.20 years old for exposure to parental IPV (sd = 4.44, range = 1–33), 10.41 years for rape (sd = 7.00, range = 0–35 ), 17.32 years for witnessing trauma to a loved one (sd = 10.25, range = 0–43), and 22.18 years for the unexpected death of loved ones (sd = 8.61, range = 1–39).

Types of Traumatic Events

Each of the five distinct traumatic event types was associated with significantly higher mean scores of depression and anxiety for those who had experienced a given trauma compared to those who did not experience that particular trauma. T-test results revealed that mean differences in depression and anxiety scores were highest for individuals who had experienced rape and physical violence by parents compared to those without these exposures. The unexpected death of loved ones had the lowest mean differences across the exposed and nonexposed groups for both depression and anxiety scores. Mean differences are presented in Table 2. Please note that individuals in the group without exposure to specific trauma may have been exposed to another type of trauma.

Table 2.

Mean Differences in Adulthood Depression and Anxiety Scores Based on Exposure to a Specific Trauma.

Types of Trauma	Depression			Anxiety
	No	Yes		No	Yes
	Mean	Mean	t	Mean	Mean	t
Violence from parents	8.51	13.28	−4.11***	4.07	7.60	−5.33***
Witnessing IPV	7.76	12.13	−4.53***	3.91	6.24	−4.21***
Rape	8.40	14.04	−4.39*	4.29	7.28	−4.12***
Witnessing trauma to loved one	8.58	11.66	−2.83**	4.29	6.16	−3.16**
Unexpected death of loved one	8.29	10.56	−2.38*	4.00	5.59	−3.00**

Note. IPV = intimate partner violence.

***

p < .001. **p < .01. *p < .05.

The results from multiple regression analyses suggested that past exposures to physical violence from parents, witnessing IPV, and rape were significantly associated with higher scores of both depression and anxiety. In addition, witnessing trauma experienced by a loved one and the unexpected death of loved ones were significantly related to higher anxiety scores. However, neither witnessing trauma experienced by a loved one nor the unexpected death of loved ones was significantly related to depression scores (see Table 3).

Table 3.

Regression Models for Exposures to a Specific Trauma and its Relationship With Adulthood Depression and Anxiety (With Covariates).

Types of Trauma	Depression				Anxiety
Types of Trauma	b	β	se	t	b	β	se	t
Violence from parents	3.00	.14	1.09	2.75**	2.68	.22	0.61	5.35***
Witnessing IPV	2.66	.15	0.94	2.84**	1.46	.14	0.55	2.67**
Rape	3.49	.16	1.32	2.87**	2.05	.17	0.70	2.93**
Witnessing trauma to loved one	1.90	.10	0.97	1.96	1.29	.12	0.56	2.31*
Unexpected death of loved one	1.74	.09	0.91	1.91	1.32	.13	0.52	2.52*

Note. IPV = intimate partner violence; se = standard error.

***

p < .001. **p < .01. *p < .05.

Exposure to a Variety of Traumatic Events

The results from multiple regression analyses showed that participants who experienced more variety of trauma had significantly higher depression and anxiety scores than those exposed to fewer trauma types. Therefore, exposure to all five types was associated with the highest depression and anxiety scores (M[sd] = 15.55[12.35]; 16.00[6.54], respectively), and exposure to only one type of trauma was linked with the lower depression and anxiety scores (M[sd] = 7.88[8.07]; 10.90[4.85], respectively). Further, individuals with no reported trauma histories had the lowest depression and anxiety scores (M[sd] = 5.44[6.00]; 9.68[3.30], respectively). On average, experiencing one additional type of trauma exposure was associated with a 1.44 unit increase in depression score and a 0.98 unit increase in anxiety score (depression: b = 1.44, β = .21, se = 0.34, p < .0001; anxiety: b = 0.98, β = .26, se = 0.20, p < .0001).

Repeated Exposure to a Single Form of Trauma

The results from multiple regression analyses suggested that an increased number of exposures to the same form of trauma—such as rape, witnessing trauma to loved ones, and the unexpected death of loved ones—was significantly associated with increased depression and anxiety scores in adulthood (see Table 4). However, for physical violence from parents, only depression, but not anxiety, significantly increased when participants had more than one exposure. Repeated witnessing of IPV had no significant effect on depression or anxiety scores.

Table 4.

Regression Models for Repeated Exposures to a Specific Trauma and its Relationship With Adulthood Depression and Anxiety (With Covariates).

Types of Trauma	Depression				Anxiety
Types of Trauma	b	β	se	t	b	β	se	t
Violence from parents	0.08	.37	0.03	3.11**	0.02	.19	0.02	1.56
Witnessing IPV	0.01	.00	0.02	0.51	0.01	.10	0.01	1.45
Rape	0.12	.39	0.03	3.93***	0.06	.37	0.02	3.32**
Witnessing trauma to loved one	0.08	.23	0.03	2.43*	0.04	.22	0.02	2.21*
Unexpected death of loved one	0.84	.18	0.30	2.84**	0.40	.15	0.17	2.30*

Note. IPV = intimate partner violence; se = standard error.

***

p < .001. **p < .01. *p < .05.

Timing of First Exposure to a Specific Trauma

The results from multiple regression analyses revealed that the unexpected death of loved ones at an early age was more strongly associated with depression scores than experiencing the death of loved ones later in life (b = −0.17, β = −.16, se = 0.07, p = .02). On the other hand, there was no significant relationship between the timing of the unexpected death of loved ones with anxiety scores. Further, no significant associations were found between the age of first exposure to other trauma types and depression and anxiety scores (see Table 5).

Table 5.

Regression Models for the Timing of First Exposure to a Specific Trauma and its Relationship With Adulthood Depression and Anxiety (With Covariates).

Types of Trauma	Depression				Anxiety
Types of Trauma	b	β	se	t	b	β	se	t
Violence from parents	0.39	.16	0.27	1.44	0.16	.11	0.16	0.98
Witnessing IPV	−0.03	.02	0.28	−0.09	−0.01	−.02	0.15	−0.05
Rape	−0.25	−.16	0.18	−1.40	−0.12	−.14	0.10	−1.23
Witnessing trauma to loved one	0.10	.09	0.10	1.01	0.01	.02	0.05	0.23
Unexpected death of loved one	−0.17	−.16	0.07	−2.40*	−0.06	−.10	0.04	−1.46

Note. IPV = intimate partner violence; se = standard error.

p < .05.

Discussion

This study furthers knowledge of how the different characteristics of trauma experiences across the life course predict depression and anxiety scores in adulthood. We examined the impact of four trauma characteristics (type, variety, repetition, and timing) of five distinct types of trauma (physical violence from parents in childhood, exposure to IPV in childhood, lifetime rape, lifetime witnessing traumatic experiences of loved ones in a lifetime, lifetime unexpected death of loved ones) on adult depression and anxiety scores. The results highlight that each trauma characteristic was important in predicting depression or anxiety for at least one of the trauma types.

We found that individuals with histories of exposure to physical violence from parents, witnessing IPV, and rape had higher depression and anxiety scores than individuals without these trauma exposures. However, individuals who witnessed trauma experienced by a loved one and experienced the unexpected death of loved ones had higher anxiety but not depression scores in adulthood than individuals without these trauma exposures. Rape had the highest mean differences in depression and anxiety scores between study participants with and without a history of rape while witnessing trauma to loved ones had the lowest mean differences in depression and anxiety scores between participants with and without this exposure. The three traumas that were most strongly associated with depression and anxiety in this study were all interpersonal traumas (childhood parental physical abuse, childhood exposure to IPV, and lifetime rape). In contrast, the two non-interpersonal traumas (lifetime unexpected death of loved ones, lifetime witnessing trauma to loved ones) had weaker relationships to the focal outcomes. These findings are consistent with previous studies which show that, although all trauma may affect mental health to some degree, interpersonal trauma is far more impactful on individuals’ mental health (Forbes et al., 2013; Guina et al., 2018; Norman et al., 2012).

Additionally, our study indicates that increased exposure to traumatic experiences (i.e., cumulative exposures to distinct types of trauma or repeated exposure to the same form of trauma) was associated with increased depression and anxiety symptoms. Hence, the finding provides additional evidence to the long-standing view that more overall trauma correlates to poorer mental health (Felitti et al., 1998; Kuzminskaite et al., 2021). Nonetheless, there was some variability in this pattern based on trauma type. For example, our finding revealed that exposure to physical violence from parents and witnessing IPV may affect adulthood depression and anxiety scores, irrespective of repetition. However, for the traumas of rape, witnessing trauma to a loved one, and the unexpected death of loved ones, more repeated exposures lead to greater harm. Thus, the characteristics of the trauma may drive the differences in the pattern (e.g., chronic, repetitive exposure compared to an acute, one-time event) (Pill et al., 2017; Wamser-Nanney & Vandenberg, 2013).

Overall, we found the effects of the timing of the first trauma exposure were minimal, with only one significant exception: earlier exposure to the unexpected death of loved ones was found to predict higher depression symptoms in adulthood. This finding contrasts with previous research conducted by Dunn et al. (2017), which found no significant relationship between age and adult depression or anxiety symptoms for any type of trauma. However, it is premature to conclude that the timing of trauma does not matter, as other studies, some of which we mentioned previously, have shown that there may be a developmental timing component associated with trauma exposure and adverse sequelae that requires further investigation (Adams et al., 2018; Dunn et al., 2017). Therefore, further studies on the timing of the onset of the first trauma are warranted.

Limitations of this study must also be noted. First, this study was based on retrospective self-reports, which may be affected by recall bias (Wilson et al., 2003). However, retrospective data can still be appropriate when studying the link between trauma and psychopathology. Research suggests the association with psychopathology is primarily driven by retrospective subjective reports rather than official records (i.e., objective reports) of trauma (Danese & Widom, 2020). However, in the case of assessing timing, we recognize that prospective data would allow for stronger conclusions as to the causal (vs. correlational) relationship between trauma events and adulthood depression and anxiety. Second, our study included both childhood and adulthood trauma events in our analysis. This decision was primarily influenced by how the questionnaires on trauma were structured (i.e., the measure does not distinguish between adversity/trauma experienced in childhood vs. adulthood). We recognize this as a possible limitation in our study, given that past research reveals a potential differential role of childhood trauma versus adulthood trauma on psychopathology outcomes (Cloitre et al., 2009). However, our findings suggest that the timing of the trauma did not play a significant role in depression and anxiety symptoms; therefore, not differentiating childhood versus adulthood trauma may have minimally impacted our study. Lastly, the study used a predominantly White sample. Although it reflects the location’s demographics at the time of data collection, the lack of diversity in the study sample is a limitation. Future studies should include more racially and ethnically diverse samples to increase the generalizability of study findings.

Results underscore the value of comprehensively considering trauma type, repetition, variety, and timing characteristics when studying the impact of trauma history. Our findings highlight that the effects of trauma can coexist and even interplay to produce negative consequences later in life. Understanding how exposure to various traumas and different trauma characteristics relate to outcomes, including depression and anxiety, can guide the development of prevention and intervention strategies. Our results support carefully identifying the effects of different trauma characteristics in addressing mental health outcomes, including types, repetition, variety, and timing. Therefore, programs and interventions designed to lessen the effects of trauma and build resilience should simultaneously consider the various types of trauma experienced by an individual over a lifetime and the probable long-term worsening impact of most traumatic experiences on individuals’ existing mental health issues.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: This research was supported by the grants from the National Institute on Child Health and Development (R21HD094961) and National Institute on Aging (R01AG059823). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institutes of Health.

ORCID iDs

Sunghyun Hong

Ashley Rousson

Lisa Fedina

Todd Herrenkohl

Author Biographies

Sunghyun Hong, MSW, MS is a doctoral candidate in the joint PhD program in Social Work and Developmental Psychology at the University of Michigan. Her interests center on the developmental shaping of resilience and the ways biological, cultural-social, and environmental factors hinder, protect, and promote the functioning of vulnerable groups.

Chi-Lin Yu, MS, is a doctoral candidate in the Department of Psychology at the University of Michigan. He studies social cognitive development in children and adults via behavioral experiments, neuroimaging techniques, and computational modeling.

Ashley Rousson, MSW, is a doctoral candidate at the University of Washington School of Social Work. Her research focuses on the intersection of intimate partner violence (IPV) and child maltreatment, with specific attention to parenting in the context of IPV.

Anna Bender, PhD is a postdoctoral scholar-fellow at Harborview Injury Prevention & Research Center, University of Washington. Her academic interests include the effects of trauma on child development and the role of relational health in promoting resilience.

Lisa Fedina, PhD is an assistant professor at the School of Social Work, University of Michigan. Her research investigates the connections between different forms of violence across the lifespan (e.g., child maltreatment, intimate partner violence, sexual assault), health, and mental health outcomes.

Todd Herrenkohl, PhD is a professor and Marion Elizabeth Blue Endowed Chair in Children and Families a University of Michigan School of Social Work. His primary research interests focus on the areas of child and family well-being, child maltreatment, the psychosocial and developmental underpinnings of health-risk behaviors in youth and adults, mental and physical health outcomes of adversity, and resilience.

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